Receiving medical services via telehealth was a requirement for some during the pandemic but has continued to grow in popularity since then.

In states such as Nebraska with large rural areas, telehealth can be especially important. Certain pandemic-era telehealth "flexibilities" allowed by the Centers for Medicare and Medicaid will expire at the end of this year, prompting a new report by the Bipartisan Policy Center.

The report, "Positioning Healthcare Policy to Ensure High-Quality, Cost-Effective Care," recommended Congress make some of the changes permanent or at least extend them.

Maya Sandalow, senior policy analyst at the center, stressed the need for more research on telehealth. She called existing research "promising" but said it shows the quality can really vary.

"By what a person is seeking telehealth for, what service a provider is offering, and also what type of telehealth a provided," Sandalow outlined. "Is it a video where the patient and provider can see each other, or is it a visit over the telephone?"

The report supported allowing patients to continue to choose the location for their telehealth visits and allowing behavioral health services via telehealth without an in-person visit first, assuming the provider has a plan for patients in a crisis. Nebraska law has required both from Medicaid and state-regulated insurance companies since 2021, and payment parity -- paying the same rate for telehealth as for an in-person visit -- since 2023. However, only the Centers for Medicare and Medicaid Services can establish the guidelines for Medicare.

Sandalow acknowledged some believe payment parity is crucial to maintain access to services, whereas others fear it may "incentivize" providers to offer only telehealth services. But she stressed there is no doubt telehealth increases access to care, especially when it comes to behavioral and mental health services.

"It can be really high quality, equally good as compared to in-person care," Sandalow contended. "We're living in a behavioral health crisis, and any measures to expand access to care are really important."

Jed Hansen, executive director of the Nebraska Rural Health Association, said in addition to improving access, some find telehealth a more comfortable way to receive mental health services, especially in smaller communities.

"It just helps create that additional privacy by being able to stay in your own home or even close the door in your office and take that meeting," Hansen explained. "As opposed to having to drive and park your vehicle in front of a mental-health place."

Sandalow emphasized the need for the Centers for Medicare and Medicaid Services to find a way to assess the quality and costs of fully virtual providers and telehealth companies in particular.

On a related note, Hansen stressed the need to ensure telehealth regulation does not make it easier for out-of-state providers to interfere with the ability of Nebraskans to maintain a relationship with their local provider.

"What we don't want to have happen are these sweeping telehealth bills, and then to have an Amazon or a Walmart, or someone on the West Coast, that may not be providing an apples-to-apples service, and they'll come in and undercut the local health care system," Hansen cautioned.

About 1.3 million Missourians are currently enrolled in Medicaid and nonprofits around the state have warned proposed federal cuts would be devastating.

In Missouri, children are the largest group served by Medicaid, with 61% enrolled. States could face more than $800 billion in Medicaid cuts and more than $200 billion in the Supplemental Nutrition Assistance Program, known as SNAP or food stamps.

McClain Bryant Macklin, vice president of policy and impact for the Kansas City nonprofit Health Forward Foundation, emphasized how important Medicaid is to the organization.

"From a policy perspective as well as where we tend to lend our funding support is squarely in that direction, and Medicaid access has been our primary policy issue, really since our inception," Bryant Macklin explained. "It's just our number one priority."

Supporters of the cuts argued Medicaid is inefficient because of waste and fraud, and restructuring or reducing funding could improve sustainability.

Bryant Macklin noted the Health Forward Foundation played a key role in advocating for Medicaid expansion in Missouri, contributing to policy changes which extended coverage to thousands of low-income residents. She stressed as a Medicaid expansion state, Missouri will need to find funding from other critical sources, which could result in further challenges.

"State legislators are going to be forced to -- and administrators forced to -- find those dollars elsewhere," Bryant Macklin pointed out. "That elsewhere will be from other key social services that folks are relying upon and that the state has grown accustomed to receiving that federal support."

Those in favor of the cuts said they would give states greater control over Medicaid through block grants, which are fixed amounts of federal funding states can use with more flexibility, to tailor programs to local needs and priorities.

Indiana is losing millions in public health funding as the federal government cuts grants for state and local programs.

In Marion County, officials confirmed the immediate loss of a $450,000 immunization grant, leaving employees searching for ways to continue vaccination efforts amid ongoing disease outbreaks.

Dr. Virginia Caine, director and chief medical officer for the Marion County Health Department, highlighted the cuts during a town hall hosted by Rep. André Carson, D-Ind.

"We are now seeing that they've cut all state and local health departments budgets," Caine explained. "We have to be very concerned about our ability to protect the public."

Caine noted the federal government eliminated $13.1 billion in funding for state and local health departments, part of a broader rollback of pandemic-era grants. Indiana Department of Health legislative director Rachel Swartwood recently commented the state's goal is to ensure no direct services to Hoosiers are interrupted.

State health officials estimate Indiana will lose about $40 million because of the cuts. Additionally, the U.S. Department of Health and Human Services recently announced plans to eliminate 10,000 full-time jobs. The totality of the cuts is very concerning for Caine.

"When we had this fentanyl epidemic with overdoes -- we have the bird flu taking place across this country -- we have to be concerned," Caine emphasized. "Do we have the workforce to come out and meet these demands?"

Marion County officials are evaluating how to fill the funding gap. Caine added the department has 300 positions supported by grants and expressed concern job losses and service reductions could follow if no alternative funding emerges.


get more stories like this via email

Oregon does not have enough health care workers and the need continues to grow.

Service Employees International Union Local 49 members said retention is a key cause of the shortage and they are lobbying for two bills in Salem to improve job quality across the industry. Over the next 10 years, health care and social services will need to bring in nearly 225,000 workers, according to the Oregon Employment Department.

Matt Swanson, political strategist for SEIU Local 49, said meeting the growing demand will take every possible intervention.

"I heard from many workers about how tired they are," Swanson reported. "How difficult it is to provide quality patient care when there just aren't enough people working."

One bill at the top of the union's priority list would address unchecked workplace violence, which health care workers experience at a higher rate than any other industry. Another would expand funding to allow providers to continue to work while going to school for advanced training.

Felipa Nesta, a licensed practical nurse at Kaiser Permanente, is using existing funding to get a nursing degree while working. She said Senate Bill 27 would help meet the growing demand for health care providers by increasing funding for such programs as well as providing wage replacement, child care, and transportation.

"It would help so more people can get into health care jobs without being buried in debt," Nesta emphasized.

Rachel Dennis, a certified nursing assistant at PeaceHealth Sacred Heart Medical Center, said Senate Bill 537 mandates de-escalation training as well as systems to notify providers of potentially violent patients. It also guarantees counseling and paycheck protection for injured employees. She noted nearly all her coworkers have faced verbal or physical assault on the job.

"I'm tired of seeing my coworkers leave because they're scared to go to work," Dennis stressed.

Both bills have had public hearings and are scheduled for work sessions in Salem.